Key Statistics and Mental Health Demographics

Prevalence of mental illness and community need

An understanding of the prevalence of mental illness across the spectrum of severity sets the context for understanding the different service responsibilities across the sector.

In total, 9.1 million people, or around 38 percent of the Australian community, have some level of mental health need. Not all require health care or professional treatment, nor will they seek formal assistance; however, when they do, it is imperative that that they receive the right care in the right place at the right time appropriate ongoing care, as well as those who have early symptoms and

to their needs. People with mild mental illnesses, estimated at 2.1 million people, in the primary mental health care system, with the bulk of services

South Australia must work towards a ‘no wrong door’ approach and integration across services, no matter where that individual sits on the spectrum of mental health need.

Nationally, one in five Australian adults (aged 16 to 85 years) will experience a mental illness each year and almost half will experience a mental disorder in their lifetime.1 Anxiety disorders approximately 14% and 6%, respectively, of the adult population each year, with these conditions often co-occurring. In addition, almost one in seven (14%) young people (aged 4 to 17 years) are estimated to have experienced a mental illness in the previous year.2

The experience of mental health conditions ranges across a wide spectrum. The most common experience is of approximately 5.4 million people ‘at risk’ who do not meet criteria for a diagnosis but who have some mental health need. This includes people who have had a previous illness and are at risk of relapse without are at risk of developing a diagnosable illness. For these people, prevention and early intervention through primary health care (mainly general practitioners), digital mental health and self-help services are most relevant. These services are predominantly the responsibility of the Commonwealth. as well as those with moderately severe mental illness, around 1.1 million people, represent the next largest groups. People with mild to moderately severe illnesses are also predominantly managed

and affective (mood) disorders are the most common, affecting currently being provided through general practice and the Medicare Better Access initiative. Again, this layer of service responsibility rests with the Commonwealth. At the highest end of the spectrum of need, there are approximately 715,000 people with severe mental illness. For this group, the responsibility for clinical services is shared between the Commonwealth and states, as well as private hospitals. The National Disability Insurance Scheme will provide support to eligible individuals experiencing the most significant disability associated with severe mental illness.3

Diagram showing population across spectrum Estimated prevalence of mental health conditions and stepped care levels of need based on severity

Well Population

Population

People in SA (approx)

Focus on promotion and prevention by providing access to information, advice and self-help resources At Risk Groups

23.1%

115,274

Increase early intervention through access to lower cost, evidence-based alternatives to face-to face psychological therapy services

Mild Mental Illness

9%

44,912

Provide and promote access to lower cost, lower intensity services

Moderate Mental Illness

4.6%

22,955

Increase service access rates maximising the number of people receiving evidencebased intervention

Source: Adapted from Figure 8, COAG Health Council (2017), The Fifth National Mental Health and Suicide Prevention Plan, Commonwealth on Australia.

Severe Mental Illness

3.1%

15,470

Improve access to adequate level of primary mental health care intervention to maximise recovery and prevent escalation. Provide wrap-around coordinated care for people with complex needs

Our Service Principles: Stepped Care

By introducing principles of stepped care across the State, we will be able to focus on service delivery that matches the needs of individuals and has a particular emphasis on early intervention and self-care. That is, the person presenting to the mental health system is matched to the intervention level that most suits their current need. They do not have to start at the lowest level of intervention in order to progress to the next step, rather they have their service level aligned to their requirements.

CSAPHN and CHSALHN mental health directorates have conducted systematic analysis and service mapping across the continuum of care, to further address: 1 Priority areas for service enhancement; and 2 Shared understanding of stepped model of care in line with the 5th National Mental Health Plan.

2017-18 Joint CSAPHN/CHSALHN stepped care service mapping across regions in country SA of mental health and suicide prevention services can be viewed here: Barossa, Hills & Fleurieu stepped care service mapping Eyre, Flinders & Far North stepped care service mapping Mild 7000 6000 5000 4000 3000 2000 1000 Limestone Coast stepped care service mapping Riverland, Mallee & Coorong stepped care service mapping Yorke & Northern stepped care service mapping

Stepped care is defined as an evidence-based, staged system comprising a hierarchy of interventions, from the least to the most intensive, matched to the individual’s needs. While there are multiple levels within a stepped care approach, they do not operate in silos or as one directional steps, but rather offer a spectrum of service interventions.

In a stepped care approach, a person presenting to the mental health system is matched to the intervention level that most suits their current need. An individual does not generally have to start at the lowest, least intensive level of intervention in order to progress to the next step. Rather, they enter the system and have their service level aligned to their requirements.

Since the introduction of PHNs nationally and the implementation of the Stepped Care Model, there has been significant growth in

CSAPHN client access across stepped levels of care

2016-17 2017-18

At Risk Groups

the choice and access for individuals in Country SA as seen below. Mental Illness

Moderate Mental Illness

Severe Mental Illness

1. ABS (2008), National Survey of Mental Health and Wellbeing 2007: Summary of Results, ABS cat. no. 4326.0, Canberra, ABS. 2. Lawrence D, Johnson S, Hafekost J, Boterhoven De Haan K, Sawyer M, Ainley J, Zubrick SR (2015), The Mental Health of Children and Adolescents: Report on the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Canberra, Department of Health. 3. National Guidance Initial Assessment and Referral for Mental Healthcare- Version 1.0 March 2019.

Key statistics in a South Australian context

Prevalence of mental illness in South Australia

Timely and accessible health care is crucial for those living in country SA who are experiencing mental disorders. This includes the provision and delivery of appropriate prevention and early intervention services, primary healthcare services and specialist mental health services that are joined up and integrated.

While research suggests that there is no difference in the prevalence of mental illness between those living in rural and remote communities to those living in the city, a Royal Flying Doctor Service research report (March 2017) 4, reveals dramatic differences in how sick people become. It states poor service access, distance, cost, and continued reluctance to seek help all contribute to higher mental illness acuity experienced by those living in rural and remote communities.

Medicare Subsidised Mental Health Related Services 2017-185 , shows that 2.5 million Australians (10.5% of the population) received Medicare-subsidised mental health specific services in 2017-2018 using mental health-specific MBS item numbers.

Of the above, 2.1 million people consulted their GP, 1.2 million people saw a psychologist or other allied health provider. A total of 400,000 people consulted a psychiatrist. (Many individuals consulted more than one of these professionals.)

In 2017-18 140.9 per 100,000 persons in South Australia presented at a public hospital emergency department (ED) for mental health related illness, comprising 4.8% of all ED presentations - higher than the national average of 115.9 per 100,000 persons and 3.6% of all ED presentations within Australia.

15.9% of these presentations in South Australia were an emergency, and 51.3% were considered to be urgent.

71

Total public hospitals

4

Total private hospitals

CSAPHN population 499,020

250,077 Male 2017 Total

16,703 Aboriginal and Torres Strait Islander

2496

Mental health services

248,943 Female

2017-18 ED mental health related presentations in South Australia were for

33.1% neurotic, stressrelated and somatoform disorders

24.7% mental disorders due to psychoactive substance abuse

11.7% for schizophrenia or schizotypal disorders 8.7% for mood disorders (ABS)

4. Bishop, L., Ransom, A., Laverty, M., & Gale, L. (2017). Mental health in remote and rural communities. Canberra: Royal Flying Doctor Service of Australia. 5. ABS. Medicare Subsidised Mental Health Related Services 2017-18, by PHN. Canberra. 6. PHIDU. Social Health Atlas of Australia: South Australia. Data by Local Government Area. The University of Adelaide: Adelaide.

Key statistics in a South Australian context

Intentional self-harm and suicide

2017 age-standardised suicide rate nationally, 12.6 per 100,000 2017 age-standardised suicide rate for greater Adelaide, 11.5 per 100,000 2017 age-standardised suicide rate for rest of SA, 18.3 per 100,000 2013-2017 age-standardised suicide rate for SA Aboriginal and Torres Strait Islander people was 25.0 per 100,0007

While suicide is an infrequent occurrence in Australia, the effects and aftermath can be both traumatic and long-lasting for families and communities alike. Across Australia, people residing in rural and remote communities have a higher risk of suicide than those living in metropolitan areas. Particular rural communities across the state experience significantly higher rates of attempts and deaths, compared to the national and state averages.

In 2017, country SA had a higher suicide rate when compared to greater Adelaide. A similar trend that was observed across most states and territories.

Five year trends (2013-2017) in the age-standardised suicide rate for the joint CSAPHN/CHSALHN service area noted a slight decrease for 2016 before increasing once again in 2017. However, overall the region saw a steady incline for the five year period (2013-2017).8

Trending with national averages, males accounted for the majority of deaths by suicide (75-85%), and this trend continued across the five-year period. Males remain a priority population especially those aged 25-44 years in regional SA.8

For Aboriginal and Torres Strait Islander people in this state, suicide remained as ranked fifth in the leading cause of death for 20132017.8

While much has been done recently to respond to local needs and identify new learnings in relation to suicide prevention strategies, the statistics show we still have much to do.

Service access and use

Collectively, CSAPHN mental health services and CHSALHN country community mental health services provided a mental health service to 20,722 clients in 2017-18.

2017-18 total clients seen by CSAPHN mental health services, 12,808 2017-18 total sessions delivered by CSAPHN mental health services, 39,634 2017-18 FY total clients seen by CHSALHN country mental health community services, 7,914 2017-18 FY total service contacts CHSALHN country mental health community, 112,292 2017-18 FY total hospital admissions run by CHSALHN country mental healt, 1,041

7. ABS Causes of Death data, 2018 8. ABS 2018, Customised report

Yorke Peninsula